Wednesday, February 24, 2010

Swine Flu - The Threat That Never Was and Six Ways To boost Immunity

For reasons that are beyond me, health authorities will not admit that they got it wrong with swine flu. In some respects this is happening on the quiet as many countries have slashed their orders for vaccines and you hear less about it. In the northern winter predictions of countless deaths have of course not materialized.In fact the flu season has been no worse than usual.

Dire predictions of swine flu at the winter Olympics were made. Not one single case has occurred. In the southern hemisphere we are preparing for the next winter, still four months away. This will be the second winter with H1N1.You would think that people who claim to be “of science” and who criticize other practitioners for being “unscientific” would use the facts from last winter and apply them. You would be wrong.

The facts are that the H1N1 virus was no more severe than any one of the usual flu viruses both in terns of numbers of cases and severity. Some people get severe symptoms with flu, some people are hospitalized and some die. This happens every year. The predictions of both cases and deaths from H1N1 were so far wide of the reality as to be laughable, if so much effort, time and money had not been wasted.

If any further proof was needed that the last winter flu in Australia was mild it came in the profit result of listed medical centre company, Primary Healthcare. In its half yearly result the company noted that attendances at general practice clinics had been flat. One reason for this cited in the half yearly report was the “lack of a flu epidemic compared to last year”.

Not only was last years flu season not worse than usual it was milder than the previous year, resulting in less visits to the doctor.

People can get things wrong. We all do. We can learn from mistakes. So what are we getting from the health department in Australia? Recognition that they were wrong? Advice to treat this winter like any other? No, we are getting dire warnings for this year.

The threat of a second wave has been raised. How can you have a second wave when there was not a first one? There is the threat that the virus will morph somehow. It was not serious last year, but somehow it will change this year and be the killer that we were all supposed to be afraid of.

To that end the Chief Medical Officer wrote to all Australian General practitioners urging them to vaccinate everyone against H1N1. It also tells us that the government will be spending more health dollars on a campaign to inform the public of the importance of getting vaccinated.

It admits that most of the 20 million vaccines bought by the Australian government have not been used. It also does not mention the spending on anti viral drugs which have been shown not to work, but that is a whole other story.

Now here is the really interesting part. Nowhere is there any mention of what the individual can do to support their immune system. There is no mention of the importance of things that make a real difference to your immune system such as

1) Eat a balanced diet with adequate fruit and vegetables as well as sources of essential fatty acids such as fish, olives (or olive oil), linseed or nuts.

2) In addition to this many people may benefit from vitamin supplements, particularly antioxidants such as vitamins A, C and E, which help the immune system. Zinc, Vitamin D and Folate supplements are also helpful.

3) Regular exercise has been shown to boost the immune system.

4) Make sure you get enough sleep, as this is the bodies recharge the battery time

5) Drink 30-35ml/kilo of water each day.

6) Most importantly examine your workload and stress levels and take steps to reduce them before they reduce your immunity to illness.

The notion that only a vaccine can protect you from the flu is wrong. According to the product information the vaccine has a variable, albeit high percentage “take” and of course it does nothing against other viruses. Your immune system is there to keep you healthy. All it needs is for you to care properly for it.

Do not get caught up in hysteria about killer flu. Do not be swayed by alarmist predictions. Be responsible for your own health.

The best way not to be sick is to be healthy.

Monday, February 22, 2010

Learning From Falling - Personal Responsibility Versus The Nanny State

Anyone who has learned to walk has fallen over. The way babies learn to put one leg in front of the other and keep balance is through practice and the neural feedback that comes from falling down. The brain fairly quickly learns what does and does not work so that the baby learns how to walk.

Without the feedback of falling we would never learn to walk. As we go through life we may fall down doing other things and learn from this too. This is both literally in learning various sports, including monkey bars as children and metaphorically when we “fall down “ in exams or in business. In fact no one who has succeeded at anything in life has done so without falling down, usually many times. Those who learn from their falls get stronger and better at what they do. They are not fearful of falling, as they understand it is part of the process of life and learning.

Try playing any football code without falling over. Try learning any snow sport without falling over. You cannot do it. This last week we have seen the Winter Olympics and there have been many falls. Australian Torah Bright fell on her first run at the snowboard half pike, got up and then nailed a perfect run on her second attempt and received the gold medal.

This, get on with it attitude, was sharply contrasted with the events in a British town which in the same week banned contestants from running in the annual Shrove Tuesday Pancake race. The event has been held since 1445. In 2010 health and safety council officials in St. Albans, Hertfordshire decided that any person caught running would be disqualified as conditions were unsafe and someone might … fall.

One contestant was quoted in the Daily Mail as saying “I have been disqualified from a running race for running”. Now if the ground is wet, and let us remember that February is winter in the UK and it is known to rain, then this has been the case since 1445.

No doubt the council officials will cite legal concerns as the reason as well as concern for injury. And therein lies the problem. Firstly, no one is forced to run in this race and anyone who does will be aware of the ambient conditions. The fact that any legal system would allow a person who has chosen to run in a contest and falls over to “blame “ the council is ridiculous and is something that governments in a number of countries need to address.

The second issue is that health and safety has gone from being a good idea to nearly a cult with some in officialdom who see it as their role to save everyone from every possible form of hurt, no matter how slight. Yet it is not possible to protect people from themselves and worse still, attempting to do so robs those people of the opportunity to learn how to manage risk themselves.

Closer to my home, a former mayor of Cottesloe bemoaned that all the fun had been taken out of playgrounds which needed to be risk free and hence provided no challenge to children. The po-faced reply from the town CEO was that playgrounds needed to conform to Australian standards. How are children to develop motor skills without some form of challenge? This again is all about legal issues and nothing to do with what is best for children.

Like all things in life there is a happy point in the middle. It is not about leaving babies unattended by fires in the hope that they will learn that fires burn you. It is also not about stopping adults from making a choice to move along a road on foot at a speed, which they feel they can manage.

The notion that adults can be protected from all risk is not only wrong but also not achievable. The notion that children can be protected from falling is also wrong and not achievable. Worse than that it is counterproductive. Governments complain about childhood obesity in one breath and make outdoor activity boring for children in the next.

What is the answer? With children it is about teaching them to manage risk in exactly the same way as they learn to walk. Falling at times will be part of this. In adults it is about taking back responsibility for our behaviors. If I fall over while running then that is not the fault of the person or entity that owns the piece of ground, it is mine.

Those of us who feel that the state has gone too far in seeking to control all aspects of life need our voices to be heard.

Friday, February 19, 2010

ADHD Drugs- Children Do Worse at School When on ADHD Drugs

Every once in a while a study emerges that fundamentally changes a particular aspect of medicine. A long term study which shows that the assumptions underpinning a particular course of treatment, are shown to be wrong. One example was the Women’s Health Initiative in 2002 that changed our view on hormone replacement therapy for women. It had been assumed for close to 20 years that the benefits outweighed the risks. Then a long-term study showed the exact opposite and almost overnight the routine recommendation to menopausal women to take HRT was changed. Today it is only used where the benefit to the individual can be assessed as outweighing the risks.

This week the same fundamental overthrowing of assumptions has happened with Attention deficit Hyperactivity Disorder (ADHD). For the last 25 years we have seen a significant increase in the number of children diagnosed with this condition and an exponential increase in the use of drugs to treat it. These “stimulant” drugs such as Ritalin and Dex-amphetamine are amphetamine derivatives and are potent. They have been known to have significant side effects particularly affecting the heart and cardiovascular system. Their use has generally been defended on the basis that the benefits outweighed the risks.

One of the main perceived benefits has been improved academic performance. Paradoxically, the use of stimulant medication seems to tranquilize to some degree children with ADHD making them more docile and more attentive in class settings. In turn it has been assumed that children treated with the drugs would do better in school than those that were not medicated.

The study released this week from the well-respected Raine Foundation is the worlds first long term research into drug use in ADHD. The children were followed for nine years. The results showed that not only did the medicated group not do better than the non-medicated group; they did worse by a factor of ten fold! Children who had been medicated had a ten fold higher rate of being identified by teachers as performing below average for age then those who had never been medicated.

The other justification for medication has been improved behavior in the child. The study showed no significant improvement in the medicated children. Their behavior was no “worse” but not better. There was a slightly increase likelihood of depression in the medicated group.

So essentially the two reasons that have been used to promote the use of stimulant medication in children have been shown to be fundamentally wrong. The strength of this study is that is long term (9 years) .It is often easy to show benefits from medication in the short term for a variety of reasons including the placebo effect. Long term is where the truth comes out

Furthermore, the children who had been medicated had a significantly higher diastolic blood pressure, which was not a short-term effect. The drugs are known to elevate blood pressure whilst in the body but it was thought that this wore off. This study showed that medicated children had ongoing higher blood pressure even after the medication was ceased. This potentially increases their risk of hypertension and heart disease in adult life.

So what does this mean for parents whose children are on these medications? The short answer is that one should be looking at getting them off. This needs to be done in consultation with your doctor. Importantly each case is different and there will be some cases where for various reasons the benefits are judged to outweigh the substantial risks. However we will expect to see a drastic reduction in the use of these potent drugs in our children.

In an upcoming piece I will outline other ways to manage and deal with behavioral issues in children.

Monday, February 15, 2010

Alcohol and Drinking Age-The Answer is to Set The Right Example

Alcohol is in the news fairly regularly. It is both the most widely used and most problematic of all the substances that we use. The thing about alcohol that sets it apart is that there is not only a safe level, but also arguably there is a level of consumption with health benefits. Modest consumption of red wine is good for the heart. Used correctly it is a social lubricant and a pleasure to enjoy. However, the problems caused by misuse of alcohol dwarf that of tobacco and all illicit drugs combined.

The problems caused by misuse and overuse of alcohol affect not only the individual through diseases including liver failure, dementia and some cancers but also others. This includes family and friends who may be subjected to violence or abuse. It also can affect total strangers if people drive under the influence of alcohol or are involved in violence in say hotels or nightclubs. Ultimately many deaths are directly attributable to the misuse of alcohol.

Now here is the thing. Alcohol itself is “inert”. In other words it is not the alcohol that is the problem. It is how people choose to use it. To use an example a knife is inert. It can be used to cut your food or it can be used to stab a person. The knife is the same. What is different is how it is used. In the same way that I have previously written about smoking as a choice, so too is alcohol use. The notion of the helpless addict is not correct and worse than that this thinking reinforces the idea that people are not able to change their behavior.

The latest call in Australia is to lift the drinking age to 21 from the current 18. There is a fundamental flaw in this thinking, which is that young people will not drink alcohol if they are under age. They already do. Lifting the legal age will not change this. Worse still it just criminalizes behavior clogging up police resources, and courts, which have better things to do.

What is needed is to teach young people about the proper use of alcohol. In this regard European cultures like the French and Italians do much better than Anglo Saxon cultures. Alcohol is seen as part of social occasions and the young are introduced to small quantities. They observe their elders enjoying a social use of wine, mainly, with meals. The way children learn most is through copying adults. This can be for better or worse.

Simply banning use has not and never has worked. Prohibition in the 1920s did not result in people not drinking. It resulted in profits for criminals. Telling people aged 18 that they can fight in wars and can vote but can not drink alcohol is ridiculous. More to the point it will not solve the issue of problem drinking as those who want to drink will do so anyway. It also assumes that it is just young people who misuse alcohol-and it is not.

We teach our children many things including how to use knives responsibly. We do not ban them from using knives till a legally set age. We let them ease into use at the age appropriate for the child. We guide them carefully until they can manage by themselves If we want to reduce alcohol miss-use in our young people we need to teach them responsible use via the same principle as we teach them to use knives.

This in reality means setting a good example.

Do as I say, not as I do, will not cut it.

Friday, February 12, 2010

Childhood Obesity - Small Changes Make a Big Difference

Childhood obesity has been put front and centre with Michelle Obama. An ambitious goal to eliminate childhood obesity in a generation has been made. There is an old quote attributed to Michelangelo that it is better to aim too high and miss than to aim too low and hit.

There is no particular reason why this goal cannot be achieved. The “Let’s Move” campaign actually is focusing on a range of initiatives. It is getting government agencies coordinated and working in collaboration with business and the media. Sports stars have volunteered to help spread the message.

Success will of course come down to individuals and families making changes and accepting responsibility for what they do. However it has been shown that simple things like repainting crosswalks helps encourage children to walk to school hence providing some exercise. Giving parents useful information about foods and dispelling myths about junk food being cheaper will also help. The support of three major suppliers of school lunches to reduce fat and sugar in their products will help too. A positive approach rather than the usual handwringing will make it far more likely that there will be success.

Health habits start in the home. A new study has demonstrated that little things make a big difference. A study of over 8000 preschool age children showed a 40% lower rate of obesity in families where three simple things were done,

1) The families ate dinner together at least five times a week
2) The children got at least 10.5 hours sleep each night
3) The children watched less than two hours television each day

These three things combined almost halved the rate of obesity. None are difficult and none are expensive. We also know that getting it right in preschool age sets the basis for the school years so this is actually the best time to act.

Meanwhile at the other end of the spectrum a study was released supporting gastric band surgery for teenagers. The study compared weight loss in 25 teenagers on a weight loss regime compared to 25 who had surgery after two years. The faults with this study are numerous including the small numbers and the short length of time. Seven of the teenagers required further surgery. The biggest issue is that a company, which makes the bands, funded the study and worse still two of the authors are on company advisory boards so are not independent.

It is already emerging that there will be long-term complications from gastric banding surgery including kidney stones and brittle bones. Interfering with the bodies absorption of food has major ramifications, most of which have not been thought about because they do not happen straight away. With teenagers who are still developing, the long-term issues are completely unknown.

The best quote on this came from AMA Vice President Steve Hambleton who said, “We should not be outsourcing self control to a surgical procedure. It means we are not doing anything about the problem, just treating the symptoms.”

I could not have put it better. Nobody is born obese. It comes from actions taken after birth. Hence the individual can change those actions. Support such as that outlined by the First Lady will assist.

Putting the right fuels into your body in the right amounts is a key part of Do It Yourself Health. It is within the power of everyone to do this.

Tuesday, February 9, 2010

Health is Your Responsibility

Children are taught from a fairly young age about the need to take responsibility for their actions. The classic tale is of Billy and Johnny standing next to a window, which has, had a brick thrown through it. An adult finding this asks who did this? To which Billy replies “ I did but only because Johnny told me to”.

Whilst Johnny may well get reprimanded for telling Billy to throw a brick through a window, Billy will be punished and told very clearly “just because Johnny tells you to do something doesn’t mean you have to do it. If Johnny told you to jump off a cliff would you do it?” The answer to this is of course no.

So the child learns that despite being egged on by peers, he needs to decide his own actions and not seek to blame others for his actions. Parents and teachers are charged with the job of teaching children about taking responsibility for their actions so that they can grow up to be responsible citizens.

It is therefore somewhat bizarre to see how often adults do not only use a variation of the excuse above but that adults are actually encouraged to use this excuse. I am of course referring to advertising. Who encourages adults to use the Jonny told me excuse- public health advocates.

The recent Health Reform Taskforce in Australia again raised the issue of ”banning” junk food advertising. This has been mooted before and is leapt on with glee by public health advocates who argue that it is an essential part of the battle against obesity.

Now wait a minute. How exactly does an ad make you obese? Apparently people are influenced by the ads and then go out and buy (and consume) foods, which are not good for them. Apparently if the ads were not there people wouldn’t do this.

Translated this is health officials telling the adult population that they are absolved from the responsibility of what they out in their mouths by being able to say “the ad told me to”. What must the average five year old who has just been sent to their bedroom for misbehavior make of this?

The other line run is that advertising in children's viewing time should be banned as children pressure their parents into buying the foods advertised. Hello!! This is little Jonny in reverse. It is now assumed that parents are so inept that they can’t decide what grocery items to buy. Being a parent means making decisions-some of which children may not like.

The bottom line is that the only person responsible for your actions is you. This is actually very empowering because if there is an aspect of your life that you are not happy with, you have the absolute power to change it.

It starts with you being responsible for what you do.

Friday, February 5, 2010

Expensive Pills are not the Answer

Whilst the health agenda in the USA has captured most of the headlines, the same issues are confronting other countries too. The central issue remains how to pay for the services, which are expected to be needed by an ageing population with a shrinking taxpayer base.

In Australia a tax review has just been completed and the third inter generational report was handed down. This looks at projections for the next generation.

One of the snippets from the tax review caught my eye. It claimed that the cost per head of pharmaceuticals in Australia had trebled in twenty years from around $200 per head to over $600 whilst in the preceding twenty years it had remained stable. This was put down to the development of “blockbuster “drugs.

The cost of drugs in Australia is much less than in the USA due to a system called the Pharmaceutical Benefits Scheme, which in simplest terms makes the government the “sole “ buyer of drugs that are listed on the scheme. So where is most of the money going?

By far the biggest spend is on cholesterol lowering drugs (statins) which accounted for AUD $1billion in 2008/09. Other biggies were reflux drugs and blood thinners at around AUD $200 million each and a common antidepressant at AUD $100 million.

The next question is what are we getting for our money? Life expectancies have continued to gradually increase over the last century by about one quarter of a year per year. This rate has not accelerated over the last twenty years. Rates of heart disease and reflux have not plummeted.

Given the amount expended on pharmaceuticals you would think that questions about benefits would be asked. By this I do not mean clinical trials, which shows that the drug “works”, I mean questions about benefits to society in terms of longevity or better levels of health. There seems to be silence on that front.

It actually gets worse. An Australian review showed that average cholesterol levels in the population had fallen 0.2 units in twenty years. This is despite a trebling in the use of statin medications since 1997 at significant cost, to “lower “cholesterol.

In the whole “healthcare” reform agenda there are always arguments about how we are going to afford the cost of disease. There are never any questions asked about ways to reduce spending on disease by people being…healthier. When one looks at the “conditions” treated by the most expensive drugs they are mainly lifestyle conditions and the cleverly coined term “risk factors”.

In other words we are treating with expensive tablets that which we have brought about through our habits be they dietary, exercise or other. Logically then, if it was not a pill that caused the problem, why is a pill the answer?

What is needed is a change in the way we look at health care. Our current systems are disease systems. The cost comes from treating disease. There is little or no support for or investment in people being healthy. A genuine health system would be looking to keep people healthy rather than pick up the pieces after they have become sick.

As individuals we need to be responsible too. Around three quarters of spending on disease is for diseases that come about not through random action but by our daily actions. We need to be responsible for our own health. Eating the right foods, being active, drinking water, managing our stress and getting enough sleep are not expensive and not difficult.

Given that “lifestyle” diseases are the major “cost” to the disease system, the solution lies not in more expenditure on treatment but in real prevention.

The best way not to be sick is to be healthy.

Tuesday, February 2, 2010

Smoking is a Choice not an Avatar

Here is something obvious-smoking is not good for you. This has been known for probably the best part of 50 years. No one in western societies who has started smoking since the mid 1970s can claim that they were not aware of this. Advertising has been virtually abolished and the packs carry warnings and sometimes pictures of diseases related to smoking such as lung cancer.

Rates of smoking have declined significantly from over 70% of adults in the 1950s to 20% or less today. Australian figures for teenagers show rates of around 5% which augers well for the future.

However despite all the information available about the problems associated with smoking some people continue to choose to smoke. Now I would encourage all of those people to quit, but some will choose not to-and that is their right. This fact though is unable to be accepted by those in public health who feel that everyone should act only in a way that is good for them and bring an almost religious zeal to their application of science.

This has led to increasingly bizarre claims, the latest of which involves the movie Avatar. One of the characters in the movie smokes. This has seen calls for the movie to have warnings about this or even a higher rating and accusations that the movie is pro smoking.

Really?? Now lets compare Avatar to another recent movie, It’s Complicated. In this there is a scene where two of the lead characters get drunk and another where two lead characters get stoned on a marijuana joint. Does this make the movie pro drunkenness or pro illicit drug use? Of course not. The film has the same classification as Avatar in Australia (although different in the USA). Was the movie Inglorious Basterds pro Nazi because some of the characters in the movie were Nazis?

Of course not and the fact that one character in a movie smokes does not make a movie pro smoking. Interestingly there has been no reaction from the holier than thou brigade to the scenes in It’s Complicated. If seeing one movie will lead to a flood of new smokers why will another not lead to the same outcome with alcohol and marijuana? Are not all three health issues?

Here is the bottom line. Cigarette smoking is a choice some people make. It is not a disease. The medicalizing of smoking with stop smoking pills together with labeling people as addicts dis-empowers them from taking charge of their health.

The choices we make are our responsibility.Blaming a movie for them is saying that we are absolved of the responsibility for our decisions because we have watched a movie.

The only person responsible for your choices is you.You have the power to make the best choices for you and in turn you will reap the benefits.